http://journals.lww.com/ajnonline/pages/viewallmostemailedarticles.aspx
en-usTue, 03 Mar 2015 15:12:54 -0600Wolters Kluwer Health RSS Generatorhttp://images.journals.lww.com/ajnonline/XLargeThumb.00000446-201503000-00000.CV.jpeghttp://journals.lww.com/ajnonline/pages/viewallmostemailedarticles.aspx
http://journals.lww.com/ajnonline/Fulltext/2015/02000/CE___Original_Research___Hospital_System_Barriers.18.aspx
Background: The goal of rapid response team (RRT) activation in acute care facilities is to decrease mortality from preventable complications, but such efforts have been only moderately successful. Although recent research has shown decreased mortality when RRTs are activated more often, many hospitals have low activation rates. This has been linked to various hospital, team, and nursing factors. Yet there is a dearth of research examining how hospital systems shape nurses’ behavior with regard to RRT activation. Making systemic constraints visible and modifying them may be the key to improving RRT activation rates and saving more lives.
Purpose: The purpose of this study was to use cognitive work analysis to describe factors within the hospital system that shape medical–surgical nurses’ RRT activation behavior.
Methods: Cognitive work analysis offers a framework for the study of complex sociotechnical systems. This framework was used as the organizing element of the study. Qualitative descriptive design was used to obtain data to fill the framework's five domains: resources, tasks, strategies, social systems, and worker competency. Data were obtained from interviews with 12 medical–surgical nurses and document review. Directed content analysis was used to place the obtained data into the framework's predefined domains.
Results: Many system factors affected participants’ decisions to activate or not activate an RRT. Systemic constraints, especially in cases of subtle or gradual clinical changes, included a lack of adequate information, the availability of multiple strategies, the need to justify RRT activation, a scarcity of human resources, and informal hierarchical norms in the hospital culture. The most profound constraint was the need to justify the call. Justification was based on the objective or subjective nature of clinical changes, whether the nurse expected to be able to “handle” these changes, the presence or absence of a physician, and whether there was an expectation of support from the RRT team. The need for justification led to delays in RRT activation.
Conclusions: Although it's generally thought that RRTs are activated without hesitation, this study found the opposite was true. All of the aforementioned constraints increase the cognitive processing load on the nurse. The value of the RRT could be increased by modifying these constraints—in particular, by lifting the need to justify calls, improving protocols, and broadening the range of culturally acceptable triggers—and by involving the RRT earlier in patient cases through discussion, consultation, and collaboration.]]>Sun, 01 Feb 2015 00:00:00 GMT-06:0000000446-201502000-00018http://journals.lww.com/ajnonline/Fulltext/2012/05000/Long_Work_Hours_for_Nurses.16.aspx
Are 12-hour shifts here to stay, despite evidence against them?]]>Tue, 01 May 2012 00:00:00 GMT-05:0000000446-201205000-00016http://journals.lww.com/ajnonline/Fulltext/2015/02000/Better_Type_2_Diabetes_Self_Management_Using.28.aspx
With clinician telehealth support, a patient learns from pre- and postmeal glucose data.]]>Sun, 01 Feb 2015 00:00:00 GMT-06:0000000446-201502000-00028http://journals.lww.com/ajnonline/Fulltext/2008/12000/Did_You_Say__Measles__.16.aspx
Many clinicians have never seen a live case. But measles is resurgent.]]>Mon, 01 Dec 2008 00:00:00 GMT-06:0000000446-200812000-00016http://journals.lww.com/ajnonline/Fulltext/2009/11001/Improving_Communication_Among_Nurses,_Patients,.6.aspx
A series of changes leads to cultural transformation at a TCAB hospital.]]>Sun, 01 Nov 2009 00:00:00 GMT-05:0000000446-200911001-00006http://journals.lww.com/ajnonline/Fulltext/2013/06000/Using_Evidence_Based_Practice_to_Reduce.27.aspx
Overview: In November 2009, AJN launched a 12-part series, Evidence-Based Practice, Step by Step, authored by nursing leaders from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Through hypothetical scenarios, based on the authors' collective clinical experience, the series illustrated the seven steps of evidence-based practice (EBP), defined as “a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values.” This article reports on an EBP project in which the seven-step approach to EBP described in the AJN series was used to reduce the incidence of catheter-associated urinary tract infection among adult patients in a long-term acute care hospital by reducing the duration of catheterization.]]>Sat, 01 Jun 2013 00:00:00 GMT-05:0000000446-201306000-00027http://journals.lww.com/ajnonline/Fulltext/2012/08000/Health_Information_Technology_and_Nursing.22.aspx
Overview: Health information technology (HIT) is a central aspect of current U.S. government efforts to reduce costs and improve the efficiency and safety of the health care system. A federal push to implement and enhance electronic health records (EHRs) has been supported by billions of dollars earmarked in the Health Information Technology for Economic and Clinical Health Act, passed as part of the 2009 American Recovery and Reinvestment Act. The goal has been to lay the groundwork for a HIT system that enables a more reliable exchange of information among practitioners and patients and significant improvements in the way care is delivered.
But what does this really mean for nurses? This article is the first in a series on HIT and nursing and will examine the federal policies behind efforts to expand the use of this technology as well as the implications for nurses. Subsequent articles will take a closer look at the use of EHRs to improve patient safety and quality of care, and the important role nurses are playing—and could play—in this system-wide initiative.]]>Wed, 01 Aug 2012 00:00:00 GMT-05:0000000446-201208000-00022http://journals.lww.com/ajnonline/Fulltext/2013/10000/CE_Test_2_3_Hours___Mouth_Care_to_Reduce.23.aspx
No abstract available]]>Tue, 01 Oct 2013 00:00:00 GMT-05:0000000446-201310000-00023http://journals.lww.com/ajnonline/Fulltext/2012/01000/Challenges_to_Health_Care_Delivery_in_U_S__Prisons.10.aspx
Aging inmates, chronic diseases, and poor follow-up after release strain the system.]]>Sun, 01 Jan 2012 00:00:00 GMT-06:0000000446-201201000-00010http://journals.lww.com/ajnonline/Fulltext/2012/07000/On_Tying_Medicare_Reimbursement_to_Patient.2.aspx
A positive experience is not synonymous with quality of care.]]>Sun, 01 Jul 2012 00:00:00 GMT-05:0000000446-201207000-00002http://journals.lww.com/ajnonline/Fulltext/2013/10000/Decreasing_Patient_Agitation_Using_Individualized.24.aspx
Overview: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated “sitters.” These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. The authors created a tool that allowed continuous observers to identify a patient's abilities and interests, and then offer such activities to the patient. Data were collected using a scale that measured patient agitation before, during, and after these activities. The authors found that during the activities, 73% of patients had decreased levels of agitation compared with baseline, and 64% remained less agitated for at least one hour afterward.
The intervention appeared effective in reducing levels of agitation in selected patients who were receiving continuous observation on nonpsychiatric units at a large, urban level 1 trauma center. Many patients expressed gratitude for the diversion from their health issues. Further investigation into the effectiveness of this intervention and its impact on the use of medications or restraints is warranted.]]>Tue, 01 Oct 2013 00:00:00 GMT-05:0000000446-201310000-00024http://journals.lww.com/ajnonline/Fulltext/2013/06000/Mental_Health_Care_in_America_s_Youths.20.aspx
Children, teens, and young adults in the wake of health care reform.]]>Sat, 01 Jun 2013 00:00:00 GMT-05:0000000446-201306000-00020http://journals.lww.com/ajnonline/Fulltext/2010/03000/Evidence_Based_Practice,_Step_by_Step__Asking_the.28.aspx
This is the third article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Ask the Authors" call-ins every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with May's Evidence-Based Practice, Step by Step.]]>Mon, 01 Mar 2010 00:00:00 GMT-06:0000000446-201003000-00028http://journals.lww.com/ajnonline/Fulltext/2014/08000/CE___Strengths_Based_Nursing.24.aspx
Overview: Strengths-based nursing (SBN) is an approach to care in which eight core values guide nursing action, thereby promoting empowerment, self-efficacy, and hope. In caring for patients and families, the nurse focuses on their inner and outer strengths—that is, on what patients and families do that best helps them deal with problems and minimize deficits. Across all levels of care, from the primary care of healthy patients to the critical care of patients who are unconscious, SBN reaffirms nursing's goals of promoting health, facilitating healing, and alleviating suffering by creating environments that work with and bolster patients’ capacities for health and innate mechanisms of healing. In doing so, SBN complements medical care, provides a language that communicates nursing's contribution to patient and family health and healing, and empowers the patient and family to gain greater control over their health and healing.]]>Fri, 01 Aug 2014 00:00:00 GMT-05:0000000446-201408000-00024http://journals.lww.com/ajnonline/Fulltext/2015/02000/Bachelor_s_Degrees_Not_Only_Save_Lives,_They_Save.8.aspx
More nurses with baccalaureates on staff shorten stays and decrease readmissions.]]>Sun, 01 Feb 2015 00:00:00 GMT-06:0000000446-201502000-00008http://journals.lww.com/ajnonline/Fulltext/2007/12000/How_to_Try_This__Detecting_Delirium.27.aspx
For patients and their loved ones, delirium can be a frightening experience. A fluctuating mental status is important to identify because it often signals a need for additional treatment. The Confusion Assessment Method (CAM) diagnostic algorithm enables nurses to assess for delirium by identifying the four features of the disorder that distinguish it from other forms of cognitive impairment. It can be completed in five minutes and is easily incorporated into ongoing assessments of hospitalized patients. (This screening tool is included in the series Try This: Best Practices in Nursing Care to Older Adults, from the Hartford Institute for Geriatric Nursing at New York University's College of Nursing.) For a free online video demonstrating the use of this tool, go to http://links.lww.com/A209 .]]>Sat, 01 Dec 2007 00:00:00 GMT-06:0000000446-200712000-00027http://journals.lww.com/ajnonline/Fulltext/2015/02000/A_Bold_New_Vision_for_America_s_Health_Care_System.23.aspx
The Future of Nursing report becomes a catalyst for change.]]>Sun, 01 Feb 2015 00:00:00 GMT-06:0000000446-201502000-00023http://journals.lww.com/ajnonline/Fulltext/2013/09000/AJN_On_the_Cover.16.aspx
No abstract available]]>Sun, 01 Sep 2013 00:00:00 GMT-05:0000000446-201309000-00016http://journals.lww.com/ajnonline/Fulltext/2010/07000/Cultivating_Quality__An_Evidence_Based_Protocol.24.aspx
Seeing the need for change—and making changes.]]>Thu, 01 Jul 2010 00:00:00 GMT-05:0000000446-201007000-00024http://journals.lww.com/ajnonline/Fulltext/2015/03000/Reconsidering_Contact_Precautions_for_MRSA_and_VRE.8.aspx
Are gowns and gloves always needed to keep patients safe?]]>Sun, 01 Mar 2015 00:00:00 GMT-06:0000000446-201503000-00008http://journals.lww.com/ajnonline/Fulltext/2012/12000/Barriers_to_Implementing_Evidence_Based_Practice.11.aspx
Getting past “We've always done it this way” is crucial.]]>Sat, 01 Dec 2012 00:00:00 GMT-06:0000000446-201212000-00011http://journals.lww.com/ajnonline/Fulltext/2015/01000/CE___The_Obesity_Epidemic,_Part_2___Nursing.23.aspx
Overview: Although there are many gaps in our understanding of the mechanisms underlying obesity, several nursing strategies have proven effective in combating this public health crisis. This article, the second in a two-part series, presents a theoretical framework to guide nursing assessment of affected patients and their families, thereby informing intervention. The authors discuss the effects of stigma and bias on the treatment of obesity; how to conduct a thorough assessment of an obese patient; the effectiveness of the most common lifestyle, pharmacologic, and surgical interventions for obesity; and issues to consider in the treatment of obese children. Part 1, which appeared in last month's issue, provided background on the epidemic; defined terms used in obesity treatment; and described pathophysiologic, psychological, and social factors that influence weight control.]]>Thu, 01 Jan 2015 00:00:00 GMT-06:0000000446-201501000-00023http://journals.lww.com/ajnonline/Fulltext/2012/02000/Bedside_Assessment_of_Enteral_Tube_Placement__.23.aspx
OVERVIEW: Since the flexible Levin tube was introduced in 1921, enteral feeding has become ubiquitous. From the out-set, nurses have been responsible for confirming the correct placement of enteral feeding tubes prior to their use for alimentation or medication administration, but current nursing practice doesn't always reflect the best evidence. Although research has established the inadequacy of auscultation to determine proper tube placement, this method is still commonly practiced. The authors examine the research that's been conducted over the past 25 years and compare the accumulated evidence with current practice, as reflected in a convenience sample of 28 New England hospitals. In addition, they evaluate various methods for assessing enteral feeding tubes and make evidence-based practice recommendations.]]>Wed, 01 Feb 2012 00:00:00 GMT-06:0000000446-201202000-00023http://journals.lww.com/ajnonline/Fulltext/2011/03000/Patient_Centered_Care.4.aspx
No abstract available]]>Tue, 01 Mar 2011 00:00:00 GMT-06:0000000446-201103000-00004http://journals.lww.com/ajnonline/Fulltext/2010/11000/Evidence_Based_Practice,_Step_by_Step__Critical.27.aspx
The process of synthesis: seeing similarities and differences across the body of evidence.
This is the seventh article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. See details below.]]>Mon, 01 Nov 2010 00:00:00 GMT-05:0000000446-201011000-00027http://journals.lww.com/ajnonline/Fulltext/2013/04000/Preventing_and_Responding_to_Acute_Kidney_Injury.29.aspx
Overview: Acute kidney injury is an independent risk factor for both prolonged length of hospital stay and in-hospital mortality. Recent analysis shows that over the past decade the incidence of acute kidney injury requiring dialysis rose rapidly in the United States, with associated death more than doubling. In 2007, the Acute Kidney Injury Network proposed a new classification system for acute kidney injury, which recognized that incremental changes in kidney function may adversely affect outcomes. By identifying the signs and symptoms of acute kidney injury in its early stages, nurses may be able to help reduce the severity of injury and contribute to improved outcomes.]]>Mon, 01 Apr 2013 00:00:00 GMT-05:0000000446-201304000-00029http://journals.lww.com/ajnonline/Fulltext/2011/12000/Breastfeeding_Promotion.2.aspx
Does passion for a cause threaten the nurse–patient relationship?]]>Thu, 01 Dec 2011 00:00:00 GMT-06:0000000446-201112000-00002http://journals.lww.com/ajnonline/Fulltext/2014/09000/CE___Champions_for_Central_Line_Care.27.aspx
OVERVIEW: In 2012, acute care hospitals in the United States reported 30,100 central line–associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network of the Centers for Disease Control and Prevention. Known to substantially increase morbidity, length of stay, and cost of care, CLABSIs are associated with a mortality rate of 12% to 25% and an additional cost of $22,885 to $29,330 per incident. Following five months with a sustained CLABSI rate of zero per 1,000 catheter days, the acuity adaptable critical care unit at Geisinger Medical Center in Danville, Pennsylvania, saw the CLABSI rate spike to 3.97 per 1,000 catheter days in March 2011, prompting a quality improvement project and, ultimately, the implementation within the unit of a champion team program to guide central line care.]]>Mon, 01 Sep 2014 00:00:00 GMT-05:0000000446-201409000-00027http://journals.lww.com/ajnonline/Fulltext/2010/07000/Evidence_Based_Practice_Step_by_Step__Critical.26.aspx
This is the fifth article in a series from the Arizona State University College of Nursing and Health Innovation's Center for the Advancement of Evidence-Based Practice. Evidence-based practice (EBP) is a problem-solving approach to the delivery of health care that integrates the best evidence from studies and patient care data with clinician expertise and patient preferences and values. When delivered in a context of caring and in a supportive organizational culture, the highest quality of care and best patient outcomes can be achieved.
The purpose of this series is to give nurses the knowledge and skills they need to implement EBP consistently, one step at a time. Articles will appear every two months to allow you time to incorporate information as you work toward implementing EBP at your institution. Also, we've scheduled "Chat with the Authors" calls every few months to provide a direct line to the experts to help you resolve questions. Details about how to participate in the next call will be published with September's Evidence-Based Practice, Step by Step.]]>Thu, 01 Jul 2010 00:00:00 GMT-05:0000000446-201007000-00026http://journals.lww.com/ajnonline/Fulltext/2010/01000/Life_Support_Interventions_at_the_End_of_Life_.26.aspx
OVERVIEW: Patients and family members often aren't aware that the use of life-support interventions at the end of life—when the body's systems and organs are failing—can have unintended consequences. Nurses need to be knowledgeable and able to communicate what they know about those consequences to patients, family members, and others on the health care team, leading to better decision making at this difficult time.]]>Fri, 01 Jan 2010 00:00:00 GMT-06:0000000446-201001000-00026http://journals.lww.com/ajnonline/Fulltext/2014/02000/It_All_Comes_Back_to_Staffing.1.aspx
Both quality of care and safety are at stake.]]>Sat, 01 Feb 2014 00:00:00 GMT-06:0000000446-201402000-00001http://journals.lww.com/ajnonline/Fulltext/2013/07000/Enhancing_Veteran_centered_care___A_Guide_for.27.aspx
Overview: There are currently 22.5 million living U.S. military veterans, and this number is expected to increase dramatically as military personnel return from Iraq and Afghanistan. Although honorably discharged veterans may qualify for health care through the U.S. Department of Veterans Affairs (VA), only about 25% of all veterans take advantage of this benefit; a majority seek services in non-VA settings. It's imperative for nurses in all civilian care settings to understand the impact that military service has on veterans’ health. This article provides an overview of veterans’ unique health care issues, focusing particularly on traumatic brain injury, polytrauma, hazardous exposures, chronic pain, posttraumatic stress disorder, military sexual trauma, substance use disorders, suicide, and homelessness. Evidence-based assessment tools and treatment guidelines for these health issues are discussed. A resource table provides telephone numbers and Web sites offering tools, educational materials, and veteran services. A second table provides detailed veteran-centered health assessment and screening questions.]]>Mon, 01 Jul 2013 00:00:00 GMT-05:0000000446-201307000-00027http://journals.lww.com/ajnonline/Fulltext/2002/06000/Nurse_Physician_Relationships__Impact_on_Nurse.40.aspx
The worsening state of the nation's nursing shortage has drawn attention to the need for more effective ways to recruit and retain nurses. For this reason, VHA West Coast (a regional division of VHA, Inc., a national network of community-owned hospitals and health care systems) conducted the Nurse-Physician Relationship Survey, targeting nurses, physicians, and executives in a large network of hospitals. VHA designed the survey to assess how these disparate groups viewed nurse-physician relationships, disruptive physician behavior, the institutional response to such behavior, and how such behavior affected nurse satisfaction, morale, and retention.
An analysis of the first 1,200 responses from nurses, physicians, and hospital executives suggests that daily interactions between nurses and physicians strongly influence nurses' morale. All respondents were very concerned with the significance of nurse-physician relationships and the atmosphere they create. And although all respondents saw a direct link between disruptive physician behavior and nurse satisfaction and retention, the groups differed in their beliefs about responsibility, barriers to progress, and potential solutions. The findings suggest that the quality of nurse-physician relationships must be addressed as facilities seek to improve nurse recruitment and retention.]]>Sat, 01 Jun 2002 00:00:00 GMT-05:0000000446-200206000-00040http://journals.lww.com/ajnonline/Fulltext/2002/05000/An_Overview_of_Palliative_Nursing_Care__Studies.30.aspx
No abstract available]]>Wed, 01 May 2002 00:00:00 GMT-05:0000000446-200205000-00030http://journals.lww.com/ajnonline/Fulltext/2014/02000/Increased_Longevity_and_Obesity_Drive_Increases_in.30.aspx
According to this study:
* As Americans live longer and obesity increases, the risk and prevalence of cardiovascular disease will increase, despite downward trends in cardiovascular disease mortality.
]]>Sat, 01 Feb 2014 00:00:00 GMT-06:0000000446-201402000-00030http://journals.lww.com/ajnonline/Fulltext/2012/11000/Professional_Licensure___Investigation_and.26.aspx
This is the second article in a three-part series on nursing boards’ disciplinary actions and what nurses need to know to maintain their license in good standing. This article discusses common reasons boards of nursing conduct investigations and take disciplinary action. The third and final article will discuss strategies for protecting your license.]]>Thu, 01 Nov 2012 00:00:00 GMT-05:0000000446-201211000-00026http://journals.lww.com/ajnonline/Fulltext/2012/01000/Clinical_News.7.aspx
Editor's note: Each January AJN examines the major stories affecting nurses and health care during the previous year. This year's top stories aren't too different from those we highlighted last January: the continuing debate over the Patient Protection and Affordable Care Act and how to fix the floundering economy continue to top our list. And while we hoped that Congress would move past its partisan squabbling to address these incredibly important issues, it didn't happen, even among members of the bipartisan deficit “super committee,” which failed to find a compromise solution to reduce the deficit. For nursing, it was all about whether the Institute of Medicine's Future of Nursing report would create change. Clinical news shows that consumers are still wary of vaccines and confused about screening guidelines; on a global level, the focus seems to have shifted from AIDS to noncommunicable diseases.]]>Sun, 01 Jan 2012 00:00:00 GMT-06:0000000446-201201000-00007http://journals.lww.com/ajnonline/Fulltext/2011/09000/Cultivating_Quality__Creating_a_Unit_Based.26.aspx
A hospital program develops clinical experts to foster best practices on every unit.
Keywords: diabetes management, evidence-based practice, pain management, quality improvement, resource nurse, skin care]]>Thu, 01 Sep 2011 00:00:00 GMT-05:0000000446-201109000-00026http://journals.lww.com/ajnonline/Fulltext/2014/08000/Medical_Marijuana___A_Hazy_State_of_Affairs_for.18.aspx
Few clear rules exist to guide prescribing and patient education.]]>Fri, 01 Aug 2014 00:00:00 GMT-05:0000000446-201408000-00018http://journals.lww.com/ajnonline/Fulltext/2005/03001/Medication_Errors__Why_they_happen,_and_how_they.5.aspx
No abstract available]]>Tue, 01 Mar 2005 00:00:00 GMT-06:0000000446-200503001-00005http://journals.lww.com/ajnonline/Fulltext/2014/04000/Meditation_for_Anxiety,_Depression,_and_Pain.33.aspx
According to this study:
* Certain types of meditation, such as mindfulness meditation, may provide health benefits, but additional studies are needed.
]]>Tue, 01 Apr 2014 00:00:00 GMT-05:0000000446-201404000-00033http://journals.lww.com/ajnonline/Fulltext/2014/12000/CE___Original_Research___The_Use_of_Surveillance.21.aspx
Background: The use of surveillance technology in residential care facilities for people with dementia or intellectual disabilities is often promoted both as a solution to understaffing and as a means to increasing clients’ autonomy. But there are fears that such use might attenuate the care relationship.
Objective: To investigate how surveillance technology is actually being used by nurses and support staff in residential care facilities for people with dementia or intellectual disabilities, in order to explore the possible benefits and drawbacks of this technology in practice.
Methods: An ethnographic field study was carried out in two residential care facilities: a nursing home for people with dementia and a facility for people with intellectual disabilities. Data were collected through field observations and informal conversations as well as through formal interviews.
Results: Five overarching themes on the use of surveillance technology emerged from the data: continuing to do rounds, alarm fatigue, keeping clients in close proximity, locking the doors, and forgetting to take certain devices off. Despite the presence of surveillance technology, participants still continued their rounds. Alarm fatigue sometimes led participants to turn devices off. Though the technology allowed wandering clients to be tracked more easily, participants often preferred keeping clients nearby, and preferably behind locked doors at night. At times participants forgot to remove less visible devices (such as electronic bracelets) when the original reason for use expired.
Conclusions: A more nuanced view of the benefits and drawbacks of surveillance technology is called for. Study participants tended to incorporate surveillance technology into existing care routines and to do so with some reluctance and reservation. They also tended to favor certain technologies, for example, making intensive use of certain devices (such as digital enhanced cordless telecommunications phones) while demonstrating ambivalence about others (such as the tagging and tracking systems). Client safety and physical proximity seemed to be dominant values, suggesting that the fear that surveillance technology will cause attenuation of the care relationship is unfounded. On the other hand, the values of client freedom and autonomy seemed less influential; participants often appeared unwilling to take risks with the technology. Care facilities wishing to implement surveillance technology should encourage ongoing dialogue on how staff members view and understand the concepts of autonomy and risk. A clear and well-formulated vision for the use of surveillance technology—one understood and supported by all stakeholders—seems imperative to successful implementation.]]>Mon, 01 Dec 2014 00:00:00 GMT-06:0000000446-201412000-00021http://journals.lww.com/ajnonline/Fulltext/2010/07000/Alarm_Fatigue_Linked_to_Patient_s_Death.8.aspx
Constant alarms can contribute to providers' failure to respond.]]>Thu, 01 Jul 2010 00:00:00 GMT-05:0000000446-201007000-00008http://journals.lww.com/ajnonline/Fulltext/2013/04000/Suicidal_Behavior_Remains_Common_Even_in_Treated.17.aspx
At least one mental disorder usually precedes suicidal behaviors.]]>Mon, 01 Apr 2013 00:00:00 GMT-05:0000000446-201304000-00017http://journals.lww.com/ajnonline/Fulltext/2014/04000/Original_Research___Using_Guided_Imagery_to_Manage.25.aspx
Background: Despite innovations in treatment, disease-related pain is still the primary cause of hospitalization for children with sickle cell disease. Pharmacologic pain management relieves pain temporarily, but adverse effects are increasingly a concern. Cognitive behavioral therapies, which include the use of guided imagery, have shown promise in changing pain perception and coping patterns in people with chronic illnesses. Few studies have been done in children with sickle cell disease.
Objectives: The purposes of this study were to test the effects of guided imagery training on school-age children who had been diagnosed with sickle cell disease, and to describe changes in pain perception, analgesic use, self-efficacy, and imaging ability from the month before to the month after training.
Methods: A quasi-experimental interrupted time-series design was used with a purposive sample of 20 children ages six to 11 years enrolled from one sickle cell disease clinic, where they had been treated for at least one year. Children completed pain diaries daily for two months, and investigators measured baseline and end-of-treatment imaging ability and self-efficacy.
Results: After training in the use of guided imagery, participants reported significant increases in self-efficacy and reductions in pain intensity, and use of analgesics decreased as well.
Conclusions: Guided imagery is an effective technique for managing and limiting sickle cell disease–related pain in a pediatric population.]]>Tue, 01 Apr 2014 00:00:00 GMT-05:0000000446-201404000-00025http://journals.lww.com/ajnonline/Fulltext/2015/03000/Interprofessional_Collaboration_and_Education.26.aspx
Working together to ensure excellence in health care.]]>Sun, 01 Mar 2015 00:00:00 GMT-06:0000000446-201503000-00026http://journals.lww.com/ajnonline/Fulltext/2014/12000/Our_Ebola_Wake_Up_Call.1.aspx
What have we learned from this crisis?]]>Mon, 01 Dec 2014 00:00:00 GMT-06:0000000446-201412000-00001http://journals.lww.com/ajnonline/Fulltext/2013/08000/Developing_a_Vital_Sign_Alert_System.23.aspx
Overview: This article describes the implementation of a nurse-designed, automated system for enhancing patient monitoring on medical–surgical and step-down nursing units. The system, which is not derived from any of the early warning scoring systems described in nursing literature, was developed and put into place at a large tertiary hospital in eastern Virginia and found to substantially reduce out-of-unit codes without increasing nurses’ workload.]]>Thu, 01 Aug 2013 00:00:00 GMT-05:0000000446-201308000-00023http://journals.lww.com/ajnonline/Fulltext/2014/08000/CE___Sustaining_Pressure_Ulcer_Best_Practices_in_a.26.aspx
Overview: Narayana Hrudayalaya Cardiac Hospital (NHCH) in Bangalore, India (now known as the Narayana Institute of Cardiac Sciences), is one of the world's largest and busiest cardiac hospitals. In early 2009, NHCH experienced a sharp increase in the number of surgical procedures performed and a corresponding rise in hospital-acquired pressure ulcers. The hospital sought to reduce pressure ulcer prevalence by implementing a portfolio of quality improvement strategies. Baseline data showed that, over the five-month observation period, an average of 6% of all adult and pediatric surgical patients experienced a pressure ulcer while recovering in the NHCH intensive therapy unit (ITU). Phase 1 implementation efforts, which began in January 2010, focused on four areas: raising awareness, increasing education, improving documentation and communication, and implementing various preventive practices. Phase 2 implementation efforts, which began the following month, focused on changing operating room practices. The primary outcome measure was the weekly percentage of ITU patients with pressure ulcers. By July 2010, that percentage was reduced to zero; as of April 1, 2014, the hospital has maintained this result. Elements that contributed significantly to the program's success and sustainability include strong leadership, nurse and physician involvement, an emphasis on personal responsibility, improved documentation and communication, ongoing training and support, and a portfolio of low-tech changes to core workflows and behaviors. Many of these elements are applicable to U.S. acute care environments.]]>Fri, 01 Aug 2014 00:00:00 GMT-05:0000000446-201408000-00026http://journals.lww.com/ajnonline/Fulltext/2014/11000/CE___Mild_Traumatic_Brain_Injury.24.aspx
OVERVIEW: Mild traumatic brain injury (mTBI) can have a profoundly negative effect on the injured person's quality of life, producing cognitive, physical, and psychological symptoms; impeding postinjury family reintegration; creating psychological distress among family members; and often having deleterious effects on spousal and parental relationships. This article reviews the most commonly reported signs and symptoms of mTBI, explores the condition's effects on both patient and family, and provides direction for developing nursing interventions that promote patient and family adjustment.]]>Sat, 01 Nov 2014 00:00:00 GMT-05:0000000446-201411000-00024